Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
(MuGSI) Healthcare-Associated Infections Community Interface (HAIC) Case Report Modified 17391 8406 0 Form and Instruction HAIC.400.1
2019 ABCs H. Influenzae Neonatal Sepsis Expanded Surveillance Form Removed 0 0 0 Form and Instruction ABC.100.3
ABCs Invasive Pneumococcal Disease in Children and Adults Modified 1270 212 0 Form and Instruction ABC 100.2
ABCs Severe GAS Infection: Supplemental Form Removed 0 0 0 Form and Instruction ABC.100.4
Active Bacterial Core Surveillance (ABCs) Case Report Modified 9840 3280 0 Form and Instruction ABC.100.1
Active Bacterial Core Surveillance (ABCs) Neonatal Infection Expanded Tracking Form Modified 370 123 0 Form and Instruction ABC 100.5
Annual Survey of Laboratory Testing Practices for C. difficile Infection Modified 160 45 0 Form and Instruction HAIC.400.8
CANDIDEMIA CASE REPORT FORM Modified 1700 1133 0 Form and Instruction HAIC.400.11
CDC's Healthcare-Associated Infections Community Interface (HAIC) Staphylococcus aureus Laboratory Survey Modified 110 17 0 Form and Instruction HAIC.400.5
CLOSTRIDIOIDES DIFFICILE INFECTION (CDI) SURVEILLANCE EMERGING INFECTIONS PROGRAM CASE REPORT Modified 16500 10450 0 Form and Instruction HAIC.400.7
Community-Associated CP-CRE Interview Modified 100 50 0 Form and Instruction HAIC.400.2
Data Elements Transferred to CDC for the HAIC Death Ascertainment Project Modified 80 1920 0 Form and Instruction HAIC.400.13
Emerging Infections Program C. difficile Surveillance Nursing Home Telephone Survey Modified 450 38 0 Form and Instruction HAIC.400.10
FLUSURV-NET: CONSENT FORM FOR PATIENT/PROXY INTERVIEW (English/Spanish) Modified 208 34 0 Form and Instruction FSN.300.2
FLUSURV-NET: PROVIDER PEDIATRIC VACCINATION HISTORY REQUEST LETTER/FORM Modified 1638 136 0 Form and Instruction FSN.300.3
FluSurv-NET Laboratory Survey Modified 240 40 0 Form FSN.300.4
FluSurv-Net Influenza Hospitalization Surveillance Network Case Report Form Modified 8640 3600 0 Form and Instruction FSN.300.1
FoodNET Lab Survey Variable List Modified 700 117 0 Form FN.200.10
FoodNet Hemolytic Uremic Syndrome (HUS) Modified 100 100 0 Form and Instruction FN.200.9
FoodNet Variable List_ (CYCLOSPORA) Modified 420 70 0 Form and Instruction FN.200.2
FoodNet Variable List_ (LISTERIA MONOCTOGENES) Modified 160 53 0 Form and Instruction FN.200.3
FoodNet Variable List_ (SALMONELLA) Modified 8550 2993 0 Form and Instruction FN.200.4
FoodNet Variable List_ (SHIGA TOXIN PRODUCING E.COLI) Modified 2900 967 0 Form and Instruction FN.200.5
FoodNet Variable List_ (SHIGELLA) Modified 2340 390 0 Form and Instruction FN.200.6
FoodNet Variable List_ (VIBRIO) Modified 460 77 0 Form and Instruction FN.200.7
FoodNet Variable List_ (YERSINIA) Modified 550 92 0 Form and Instruction FN.200.8
FoodNet Variable List_(CAMPYLOBACTER) Modified 5500 1925 0 Form and Instruction FN.200.1
HAIC Invasive Staphylococcus aureus Supplemental Surveillance Officer Survey Modified 10 2 0 Form and Instruction HAIC.400.6
HAIC MuGSI KPC and NDM Treatment Collection Form New 600 600 0 Form and Instruction HAIC.400.14
HAIC Multi-site Gram-negative Surveillance Initiative (MuGSI) Supplemental Surveillance Officer Survey Modified 11 4 0 Form and Instruction HAIC.400.3
HAIC-Surveillance Officer's Survey Modified 10 3 0 Form and Instruction HAIC.400.9
HAIC_LABORATORY TESTING PRACTICES FOR CANDIDEMIA QUESTIONNAIRE Modified 200 47 0 Form and Instruction HAIC.400.12
Invasive Staphylococcus aureus Healthcare-Associated Infections Community Interface (HAIC) Case Report Modified 7880 3809 0 Form and Instruction HAIC.400.4
Total burden requested under this ICR: 89088 40733 0  
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